HomeMy WebLinkAboutPermit Plumbing 2013-5-15 •
SPRINGFIELD -- - 225 Fifth St
( CITY OF SPRINGFIELD Springfield,OR 97477
:- tor
Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00967
wwx.springtieldor.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 05/15/2013 EXPIRES: 11/10/2013
STATUS DATE: 05/15/2013 APPLIED: 05/15/2013
SITE ADDRESS: 123 GREENVALE DR,Springfield, OR 97477 SCOPE: Plumbing Only
• ASSESOR'S PARCEL NO: 1703262201300 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace water line,60'
OWNER: RIEL ALISA R Phone Number:
ADDRESS: 123 GREENVALE DR
•
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor JENCOURT ENVIRONMENTAL SERVICES LLC COB 182531 06/11/2014 541-689-1711
•
INSPECTIONS REQUIRED 1
Inspections
3315 Water Line
By signature, I state and agree,that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the
Ordinances of the City of Springfield and the Laws of the State or Oregon pertaining to the work described herein, and that NO
OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further
certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree
to ensure that all required inspections are requested at the proper time,that each address is readable from the street, that the
permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during
construction. I
(!/ G 43"-Ci 5 • /
Owner or Contractor Signature Date
NOTICE: ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
THIS PERMIT EXPIRE THE WORK Notification Center. Those rules are set forth
AUTHORIZED UNDER R THIS PERMIT MIT IS NOT in OAR 952-001-0010 through OAR 952-001-
COMMENCED OR IS ABANDONED FOR .0090. You may obtain copies of the rules by
ANY 180 DAY PERIOD, calling the center. (Note: the teleph
number for the Oregon Utility Notification
- Center is 1-800-332-2344).
Springfield Building Permit 5/15/2013 2:36:36PM Page 1 of 1
SPRINGFIELD--- CITY OF SPRINGFIELD
j 225 Fifth E�oN TRANSACTION RECEIPT Spnngfield,OR97477
541-726-3753
811-SPR2013-00967
www.springfieldor.gov 123 GREENVALE DR permitcenter@spnngfield-or goy
RECEIPT NO: 2013000955 RECORD NO:811 SPR2013-00967 DATE:05/15/2013
(o> {e�;1�h1fa7:+1r : ,. -t a:11w4 ..t'ACCOUNT<CODErLRANS'CODE _3.AMOUNT1DUE='r'
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.02
Technology fee(5%of permit total) 100-00000-425605 2099 4.18
Water Line 224-00000-425603 1005 83.50
TOTAL DUE: 97.70
PAV I EN7 TrYPEy PAYOR�M`'cns- Er a nriPEN Er COMMENTS. ,mar- y Ol.NNTIPAID „y;* -.I
Check JENCOURT ENVIRONMENTAL 97.70
1166 SERVICES LLC
TOTAL PAID: 97.70
•
Plumbing Permit Application DEPARTMENT.USE ONL''Y
✓wi g50 ',L . SPRINGFIELD 3t ' ' _
s g C I T r O K S P R I N G E T E L I T -O.R E G G N P ,-A. s~„''''.,! Permit no.: S17- c1627
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 Date: c---7 , S (I )3
This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits
expire if work is not started within 180 days of issuance or if work is suspended for 180 days.
LOCAL"GOVERNMENT APP.ROVALa :'fnk„t 'f'- t „), t, .,- ,°FEESCFIEDULE , } , ,,,z
Zoning approval verified? ID Yes ❑No 7:Description ! ,7 fry l,,, „aa Qty 1 Cost +'Total
Sanitation approval verified? ❑ Yes ❑No e "t'” , "'"'��'L`r.4 °�,:d ea_ cost_„i
New residential
--`` CATEGORY„OF.a'CONSTRUCTION 21 ° '' °- Ibathroom/1 kitchen(includes:first
IZ'xesidential ❑Government ❑Commercial
100 bibs, ice maker, underfloor lines, hose $262.00 $
bibs, ice maker, underfloor low-point
5,='-,121 t JOB'-'SITE'i INFORMATION,SAND LOCATI 9N C > >, drains and rain-drain packages)
Job site address: / en......-Aeth 'dt: 2 bathrooms/1 kitchen $411.00 $ -
C/✓�”' �77 �� 3 bathrooms/1 kitchen $483.00 $
City: C� State: ZIP: !y Each additional bathroom(over 3) $104.50 $
Reference: Taxlot.: Each additional kitchen(over I) $104.50 $
a r z t, 4,`;`':`DESCRIPTION"OF,-WORK; 't'` ;' ai"-��'r. I Residential fire sprinklers(includes plan review)
0 to 2,000 square feet $80.00 $
� „ 2,001 to 3,600 square feet $128.00 $
�
O
x ,.."-' y,'¢ g,`;x ±*PROPERTY'OWNER `Tb l }= N 3,601 to 7,200 square feet $192.00 $
(r / 7,201 square feet and greater $255.00 $
Name: 6'2,60_01 'c-r/l Manufactured dwelling or pre-fab(circle one)
Address: a Ge
/y'��Cq �'C._ Connections to building sewer and
/ water supply $80.00 $
City: C State: ZIP: ' 7 V7 Commercial,industrial,and dwellings other than one-or
Phone] 4'/ �2de Fax: - - two-family
E-mail: - Minimum fee $80.00 $
This installation is being made on residential or farm property Each fixture $21.00 $
owned by me or a member of my immediate family, and is Miscellaneous fees
exempt from licensing requirements under OAR 918-695-0020.. 100' storm,sewer,water line I ( $83.50 $)5�
Signature: Each fixture,appurtenance,and piping $21.00 $
` ... ' ''CONTRACTOR':•INSTALLATION ,r';„',Y, ;;t,;c Storm water retention/detention facility $21.00 $
Business name`s/j�,rti,'i, 7- C'.'UV/Q0�n,,,t/T/�G- Irzigation systems $21.00 $
`-Y ��"-` Piping or private storm drainage
Address:(((��� I U y'S' W /S 7- ,,e systems exceeding the first 100 feet . $21.00 $
City: >j�p o„_ State: ZIP:) ycJL_. Specialty fixtures $21.00 $
_ x�_ _' Reinspection(no.of hrs.x fee.per hr.) $80.00 $
Phone: jj -6 n /7/7 Fax: - -
Special requested inspections(no.of $80.00 $
E-mail: • hrs.x fee per hr.)
CCB license no.: /6253/ BCD license no.: _ Each additional inspection:(1) $80.00 $
g _76 68 c // .fMedtcal gas pxpmgkggiz `u t"5 ,�..` n Minimum fee $
Plumbing license no.:
Print name: Wei,?'"hf A 2('pat; I Enter value of installation and equipment$ .
Enter fee based on installation and equipment value. $
Signature: La _"_ ^'"u N APPLrICANT5 USE ',Y . .$* '�� t4
• (A) Enter subtotal of above fees
(Minimum Permit Fee$80.00) $ V /mh�
55
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ / p°2-
(D)Technology Fee(5%of[A]) $ [jia
TOTAL fees and surcharges(A through D): $ 97 7°
440-2500-1(4/1/2013/COM)